Jeffrey Caso All-ceramic restorations can give us a great esthetic result in most cases. When properly fabricated, the material gives us the best ability to mimic tooth structure. The tooth shade must be matched perfectly and the surface texture needs to be spot-on as well. What really makes or breaks the esthetics is what it is placed on. The stump shade is so critical when dealing with ceramic in the esthetic zone.
Stumps can be dark for many reasons. Usually, we are dealing with teeth that have had root canal therapy. Trapped blood in the pulp chamber can cause pigment, primarily from Iron, to enter the dentinal tubules and stain the tooth. Dealing with these dark teeth before the final restoration is made and cemented will help to avoid disappointment.
We can use opaque composite resin to help hide the color, use a restoration with a core like a PFM, or attempt to bleach out the stain. I recently found a very effective method to remove the stain once and for all.
For a long time a walking bleach technique was available, but it was not without its risks. The potential for root resorption was high and it was a chance that I was unwilling to take. The use of sodium perborate has reduced this risk greatly. The added precaution of placing a composite plug in the root and over the gutta percha gives me more peace of mind. I would mix the sodium perborate with saline and place it in the root canal access and cover it with Cavit. Then change it weekly. Some responded and some didn't.
Recently, I heard that instead of using saline it would work better if you mixed the sodium perborate with hydrogen peroxide. Wow, did this make a huge difference. In the few cases that I have used this new mixture, the results have been spectacular. Not only a better result but in a much faster time. After the first week, you can see the dark pigment work its way out of the tubules.
Give it a try. You can even prep the tooth for its final restoration and place the sodium perborate mixture and then seal it in under a temporary crown. You will see the result through the crown at each visit. You will be thrilled with the results.
